Provider Demographics
NPI:1477705259
Name:KELLETT, LYNN RAE (MSN, CPNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:RAE
Last Name:KELLETT
Suffix:
Gender:F
Credentials:MSN, CPNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47809-1903
Mailing Address - Country:US
Mailing Address - Phone:812-237-3883
Mailing Address - Fax:812-237-8246
Practice Address - Street 1:567 N 5TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-1903
Practice Address - Country:US
Practice Address - Phone:812-237-3883
Practice Address - Fax:812-237-8246
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002444A363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400015772Medicare PIN